Delayed Diagnosis After Atypical Glandular Cells on Cervical Cytology

Objective. This study evaluated the prevalence of clinically significant delayed diagnosis after a negative evaluation for a Pap test with atypical glandular cells (AGCs). Materials and Methods. From 1998 to 2003, all Pap tests at Hartford Hospital were reviewed. Women with a negative comprehensive evaluation within 12 months of initial AGC cytology were included. Subjects were excluded if they had no uterus, had less than 12 months of follow-up, had a history of AGC, or had known cervical or uterine disease likely to account for the AGC Pap test. A delayed diagnosis was defined as histology of cervical intraepithelial neoplasia (CIN) 2 or greater that was diagnosed more than 12 months from the initial AGC Pap test. Results. Of the 380,744 Pap tests, 892 (0.23%) had AGCs and 176 met study criteria. Nineteen of the 176 (10.8%) had a delayed diagnosis, including 8 (4.5%) with a malignancy. Women with persistent AGCs had a significantly higher (p <.001) prevalence of a delayed diagnosis. There were 9 patients (5.1%) with CIN 2,3. The remaining diagnoses were classified as a cervical cancer, a glandular disease, or an extrauterine cancer. Women with a cervical cancer or a glandular disease were diagnosed earlier than women with CIN 1,2,3 (p = .041). Conclusions. Women who developed a delayed cervical cancer or glandular disease were diagnosed significantly earlier than women with a CIN. Women with an AGC Pap test, despite a negative comprehensive evaluation, may be at increased risk for clinically significant disease, especially if they have persistent AGC cytology.